tbuckley/cabot-search huggingface dataset:
Abstract 11144: Cardiac Imaging Procedural Volume and Reimbursement Among Medicare Beneficiaries During Covid-19 Pandemic: An Observational Study From 2018 to 2020
Authors: Ayman R Fath, Amro Aglan, Abdulbaril Olagunju, Bishoy Abraham, Abdullah S Eldaly, Juan Kamar, Nawfal Mihyawi, Aditya Khurana
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic has had major impacts on all healthcare services, including cardiac imaging. In this study, we investigate annual changes in cardiac imaging procedural volume and reimbursement among Medicare Beneficiaries (MB) from 2018 to 2020. Methods: We used the Center of Medicare and Medicaid Services database to identify a 100% sample of MB who underwent cardiac imaging procedures from 2018 to 2020. Using the Current Procedural Terminology (CPT) codes, we identified transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), stress echocardiogram, and nuclear stress test procedures. We examined each procedure’s total, inpatient (facility), and outpatient (non-facility) annual volumes per 1,000 MB. We also examined the total annual Medicare reimbursement per imaging type during that period. We compared annual changes in volumes and total reimbursement between two-time intervals: 2018-2019 and 2019-2020. Results: All annual cardiac imaging procedural volumes decreased significantly in 2020 compared to 2019 ( P&lt;0.001 ). The biggest change was observed in TEE, which decreased by 29.20%, followed by stress echocardiography (26.01%), nuclear stress test (22.96%), and TTE (10.68%). The decrease was more evident in the inpatient setting. Inpatient stress echocardiography decreased by 27.04% (vs 23.82% in the outpatient setting), nuclear stress test decreased by 24.82% (vs 20.66%), and TTE decreased by 11.03% (vs 9.58%). There was also a significant reduction in total annual reimbursement for all procedures in 2020 compared to 2019 ( P=0.0015 ). Stress echocardiogram, nuclear stress test, TEE, and TTE reimbursement decreased by 28.08%, 24.00%, 21.11%, and 15.79%, respectively. Conclusions: The COVID-19 pandemic was associated with a significant and abrupt reduction in annual cardiac imaging procedural volumes and total reimbursement among MB in both inpatient and outpatient settings.
Abstract 11722: Trends and Outcomes of Mechanical Circulatory Support in Pregnancy
Authors: Anas A Alharbi, Mohamed Al Hajji, Bandar AlYami, yasar sattar, sudarshan balla
Journal: Circulation (2022)

Introduction: Although cardiogenic shock is a rare presentation in pregnant patients, recent advances in advanced heart failure improved the survival in this particular group. In this abstract, we will present the trend of mechanical circulatory support (MCS) use in pregnancy and its inpatient outcomes. Methods: We used the national inpatient sample database between 2016 and 2019 to select all pregnancy admissions who underwent mechanical circulatory support using the tenth revision international classification of diseases. Results: The trend of MCS use did not change significantly during the study period (Figure 1). Around 23.9% of patients died during the same admission. Patients who survived had a mean of 16 days of hospital stay. About 31% of patients were discharged home, 15.5% were discharged to skilled nursing facilities and 15.5% were discharged to short-term hospitals or rehab (Table 1 and 2) Conclusions: The trend of mechanical circulatory support use in pregnant patients did not change significantly during the study period. Around one fourth of patients died during the same admission.
Abstract 11485: Neighborhood Childhood Opportunity Index is Associated With Impaired Exercise Performance in Pediatric Heart Transplant Patients
Authors: Jonathan Edelson, Meghan Lane-Fall, JING HUANG, Zi Wang, Laura M Mercer-Rosa, Jonathan Mitchell, Stephen Paridon, Matthew J O'Connor, Joseph Rossano, Michael O'Byrne
Journal: Circulation (2022)

Introduction: Pediatric heart transplant (HT) patients have impaired exercise performance which cannot be fully explained by cardiac limitations. Environment may influence physical activity and consequently exercise performance, but the degree to which environmental factors are associated with exercise performance is unknown. Methods: This cross-sectional study included 8-18y HT recipients, evaluating the association of the childhood opportunity index (COI) with maximum oxygen consumption (max V02) during cardiopulmonary exercise testing. Geospatial techniques were used to map subject addresses onto corresponding measures of the COI which includes neighborhood level indicators of 3 domains: education, health and environment, and social and economic. Higher values indicate more favorable COI scores. Results: Of the 32 patients included in the study, 16 were female, 10 self-identified as Black, and nearly 2/3 had congenital heart disease (n=18). The median duration from HT was 6.2y (IQR 2.3-12.4). The majority (n=20) had a normal cardiac index (CI &gt; 3 L/min/m2) and pulmonary capillary wedge pressure &lt; 10mmHg (n=20) on cardiac catheterization closest to exercise testingThe median COI was 79.0 (IQR 47-90; Figure 1a) and the median max V02 was low at 28 ml/kg/min (IQR 22-33). In a multivariate adjusted model, worse COI was independently associated with reduced max V02 (p=0.04 ) (Table 1, Figure 1b) Conclusions: Childhood opportunity index is associated with impaired exercise performance after HT independent of cardiac status, suggesting an impact of environmental factors on the health of HT recipients.
Abstract 11735: Single-Nucleus RNA Sequencing Analysis Reveals Subpopulation of Endothelial Cells Activation in Hearts of Porcine Double Injury Model
Authors: Thanh M Nguyen, Yuhua Wei, Yuji Nakada, Jianyi J Zhang
Journal: Circulation (2022)

Pigs underwent a double injury model: neonatal day 1 apical resection (AR P1 ) and postnatal day 28 LAD ligation (MI P28 ) can remuscularize the AMI by postnatal day 56 (P56) with little evidence of myocardial scarring, which is accompanied by increased cardiomyocytes (CMs) cell-cycle activity. The vascularization that occurred to support remuscularization has not been studied. Therefore, we analyze the single-nucleus RNA sequencing (snRNA-seq) data collected from the MI-border zone of AR P1 -MI P28 , MI P28 (without AR P1 ), naïve, and fetal pig endothelial cells (ECs) using the Artificial Intelligence autoencoder and cluster analyses. Three clusters of EC were identified. Among them, vascular and lymphatic EC clusters (EC1 and EC2) were presented in all postnatal hearts. Besides expressing vascular EC gene signatures, the remaining cluster, named ‘EC3’, also upregulated Transforming grow factor-beta (TGFβ) and Bone Morphogenetic Proteins (BMP) signaling markers. The signaling indicated EC3 was still under development. EC3 strongly presented in the fetal heart (31% of ECs); then, EC3 proportions decreased as the pig matured and virtually dismissed (&lt;2%) in the naïve heart from P28 to later. Up to 1-week following MI P28 injury, EC3 proportions remained low (&lt;2%) in MI P28 -only hearts; meanwhile, EC3 proportions significantly increased (&gt;7%) in the regenerative AR P1 -MI P28 hearts. Thus, in the AR P1 -MI P28 injured hearts, the subpopulation of EC3 is activated to support remuscularization. Figure. SnRNA-seq analysis identifies a cluster of under-development endothelial cells (EC3). A) UMAP: three EC clusters. B) UMAP: vascular EC marker PLVAP expressesed (calculated using Seurat) in EC1 and EC3. C) UMAP: lymphatic EC marker CCL21 expressesed in EC2. D) Heatmap: TGFβ and BMP signaling upregulated in EC3. C) Bargraph: proportions of EC3 in naïve and injured hearts on postnatal days P28, P30, and P35; P-value and Fold-change (FC) were calculated using Fisher’s exact test.
Abstract 11227: A Rare Case of Echo Contrast Anaphylaxis Complicated by Acute Coronary Syndrome
Authors: Rachael Steinhauer, Satoshi Miyashita, Luisa Maslon, Haval Chweich, Brian Downey
Journal: Circulation (2022)

Introduction: Contrast agents in echocardiography are used frequently to enhance endocardial border visualization and assessment of structural heart disease. Sulfur hexafluoride lipid type A injectable suspension is a generally well-tolerated class of contrast. Anaphylaxis to these agents is exceedingly rare. We now report the first case of acute coronary syndrome in the setting of echo contrast anaphylactic shock. Case: A 49-year-old woman was hospitalized for an ST-elevation myocardial infarction (STEMI) for which a drug-eluting stent had been placed in the left anterior descending artery (LAD). An echocardiogram was performed to evaluate for structural heart disease. Shortly after administration of echo contrast the patient developed sudden-onset tachypnea and suffered a pulseless electrical activity cardiac arrest. She was treated for anaphylactic shock with epinephrine and high-dose steroids and achieved return of spontaneous circulation. Following the arrest an electrocardiogram revealed an anterolateral STEMI. The patient immediately underwent repeat angiography which revealed a 100% in-stent thrombosis of the LAD. The occlusion was successfully revascularized with a drug eluting stent with an Impella CP (Abiomed, Danvers MA) support. Subsequent laboratory exam demonstrated an elevated blood tryptase level consistent with an anaphylactic event. Discussion: We present a unique case of anaphylactic shock with acute coronary syndrome following administration of sulfur hexafluoride echo contrast. The incidence of anaphylaxis to echo contrast is less than one per million, and therefore it may not be immediately recognized as a mechanism of shock. Any prior reactions to polyethylene glycol should be noted before using these agents as this ingredient is thought to be the cause of anaphylaxis. In our case, diagnosis of anaphylaxis was confirmed by measuring the serum tryptase level. Tryptase is released from mast cells during allergic events, so this laboratory test with high specificity for anaphylaxis can be a useful tool in challenging cases such as this. Additionally, mast cell and platelet activation secondary to anaphylaxis may be an important mechanism of acute coronary syndrome with in-stent thrombosis.
Abstract 11309: Lipoprotein(a) and the Pooled Cohort Equations for Risk Prediction: The Multi-Ethnic Study of Atherosclerosis
Authors: Harpreet S Bhatia, Rishi Rikhi, Tara Allen, Calvin Yeang, Weihua Guan, Parveen K Garg, Michael Y Tsai, Michael H Criqui, Michael D Shapiro, Sotirios Tsimikas
Journal: Circulation (2022)

Introduction Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) but is not included in the ACC/AHA ASCVD Risk Estimator based on the Pooled Cohort Equations (PCE). Methods We evaluated the association between Lp(a) &gt;50 mg/dL and risk for cardiovascular disease (CVD) events using multivariable Cox proportional hazards models stratified by ASCVD risk category in individuals free of baseline ASCVD with elevated Lp(a) in the Multi-Ethnic Study of Atherosclerosis (MESA). We then evaluated actual versus PCE-predicted risk by comparing 10-year CVD event rates in those with Lp(a) &gt;50 mg/dL versus Lp(a) ≤50 mg/dL using Poisson regression with adjustment for the components of the PCE by strata of risk (&lt;5%, 5-7.5%, 7.5-20%, ≥20%). We then evaluated the change in the C-index and continuous net reclassification improvement (NRI) with the addition of Lp(a) to the PCE. Results: In participants with borderline risk (5-7.5%), elevated Lp(a) was associated with greater risk for CVD events (HR 2.59, 95% CI 1.41, 4.78). Among patients with elevated Lp(a), the greatest discrimination of risk was present in those with borderline (5-7.5%) predicted risk, where the PCE significantly underestimated risk (observed rate: 8.9% for Lp(a) &gt;50 mg/dL vs 4.1% for Lp(a)≤50 mg/dL, risk ratio 2.54, 95% CI 1.35-4.62, Figure ). In this group, addition of Lp(a) to the PCE resulted in C-index improvement of 0.063. The continuous NRI with the addition of Lp(a) for CVD was 0.0386 (95% CI -0.0115, 0.1087) overall, but 0.3142 (95% CI 0.0350, 0.6083) among those at borderline predicted risk. Conclusions: The PCE underestimates risk in individuals with borderline predicted risk and elevated Lp(a). The addition of Lp(a) to the PCE improves risk prediction in individuals with borderline risk, for whom the greatest opportunity to guide treatment decisions exists.
Abstract 11535: Eicosanoid Metabolites Associations With Pulmonary Hypertension
Authors: Athar Roshandelpoor, Jenna McNeill, Arrush Choudhary, Mona Alotaibi, Mohit Jain, Susan Cheng, Gregory Lewis, Jennifer E Ho
Journal: Circulation (2022)

Introduction: Systemic inflammation may play a central role in development of pulmonary hypertension (PH). We examined the association of eicosanoid metabolites (upstream regulators of pro- and anti-inflammatory activity) with PH. We hypothesized that multi-site sampling would reveal transpulmonary release or uptake of specific PH-associated eicosanoids. Methods: We studied 482 patients with preserved LVEF who underwent right heart catheterization. PH was defined as mean pulmonary artery pressure &gt;20mmHg. Eicosanoid metabolites (n=888) were assessed using a mass spectrometry-based platform. We examined the association of eicosanoids with PH status using multivariable logistic regression. Multi-site sampling from radial and pulmonary arteries was conducted and differences assessed using paired t-tests. Analyses were deemed significant at FDR q&lt;0.05. Results: Among 482 patients (56±16 years, 62% women), 200 (41%) had PH. Of 888 eicosanoids, 59 were associated with PH (FDR q&lt;0.05; p&lt;0.004 for all). Of these, 38 were known eicosanoid metabolites/classes and the rest were novel eicosanoids. Known metabolites including linoleic acid (12,13 EpOME) and eicosapentaenoic acid derivatives (11[12]-EpETE) were associated with lower odds of PH; by contrast leukotriene (LTB4) and arachidonic acid derivatives (11,12 diHETrE) were associated with higher odds of PH. Eighteen of 59 observed eicosanoids had concomitant transpulmonary gradients (Figure; FDR q&lt;0.05; p&lt;0.003 for all). Most metabolites associated with higher odds of PH displayed transpulmonary uptake, and those with lower odds of PH displayed transpulmonary release. Conclusions: We found specific eicosanoid metabolites including linoleic acid derivatives, thromboxanes, and leukotrienes were associated with PH. Further, transpulmonary gradients indicated potential physiologic relevance. Further studies are needed to elucidate the role of specific eicosanoids in the pathogenesis of PH.
Abstract 11339: Rates of Hospital Admissions for Syncope in the United States Using a National Database
Authors: Emily S Edwards, Chen Bai, Madeline Smoot, Osama Dasa, John W Petersen, Stephen Kimmel, Mamoun Mardini, Mohammed Ruzieh
Journal: Circulation (2022)

Introduction: Syncope accounts for 1% of emergency department (ED) visits, and a significant proportion of patients become hospitalized. Most causes of syncope are benign and can be evaluated in the outpatient setting. The yield for hospitalization and inpatient workup of syncope is low. In this study, we sought to characterize trends of syncope ED visits resulting in hospitalizations. Methods: We used data from the IBM MarketScan Research Database, which captures de-identified individual-level health data from approximately 100 commercial payers and self-insured corporations in the United States, not including Medicaid claims. We identified patients presenting to the ED for syncope from 2010-2020 using ICD-9 and ICD-10 codes. Subsequently, the number of hospital ED admissions (both observation and inpatient admissions) was calculated. Results: We identified 1,737,382 ED visits from 2010-2020. There was a significant reduction in hospital admissions for syncope (11.5% to 1.4%, p&lt;0.001). In contrast, observation rates increased (5.4% to 8.5%, p&lt;0.001), figure 1A. The rate of discharge home from the ED increased (83.1% to 90.1%, p&lt;0.001). The same trends were seen for patients younger or older than 65 years, figures 1B and 1C, respectively. Nonetheless, the admission or observation rate was significantly higher for older patients (15.5% vs. 8.6%, p&lt;0.001). Conclusions: Hospital admissions for syncope declined over the past decade. There is a need to assess if this has affected mortality or recurrent ED visits for syncope.
Abstract 11121: In-Hospital Outcomes of Aortic Dissection in Patients With Substance Use Disorder
Authors: Favour Markson, Ali Horoub, Tasnim Sholi, FNU Farukhuddin, Michael Fatuyi, Yazan Al Jabiri, Mohammad Diabat, Mohannad Al-Khateeb, Richard Orji, Onoriode Kesiena, Yassine Kilani, Mubarak Yusuf, Muhammad H Maqsood
Journal: Circulation (2022)

Introduction: Substance Use Disorder (SUD) is a chronic relapsing disease emanating from the uncontrolled use of drugs despite devastating physical, neurologic and psychological consequences. Studies have proven an association of SUD with a variety of life-threatening cardiac conditions. Aortic dissection (AD) is an acute condition caused by a tear in the inner layer of the aorta and requires immediate intervention. Our study aimed to ascertain the in-hospital outcomes of patients with substance use disorders presenting with Aortic dissection using a national representative sample. Methods: This was a retrospective study done using the 2016-2019 National inpatient sample, ICD 10 codes were used to identify individuals who were admitted for aortic dissection who were further categorized into two groups based on a history of SUD or not. Multivariate analysis was used to control for confounders and assess in-hospital mortality and other hospital outcomes. Results: A total of 63,380 patients were admitted for Aortic dissection during the study period. 26% (16,775) of the population sample had active abuse of at least 1 substance. AD was identified in a younger age group with SUD vs those without SUD with a mean age of 57. vs 65 years respectively. 68% of patients with SUD were found to be males with the predominant race being white (56%). A higher proportion of SUD patients had co-morbid Hypertension (60%) and smoked Cigarette (92%). Comparing both groups, there was no statistical difference in in-hospital mortality (AOR 1.06, 95% CI 0.88-1.26, p=0.50). However, there was a higher risk of acute coronary syndrome (AOR 1.77, 95% CI 1.20-2.40, p= 0.01), Cardiogenic shock (AOR 1.26, 95% CI 1.01-1.57, p&lt; 0.001) and Embolic stroke (AOR 1.33, 95% CI 1.05-1.67, p=0.019) in the SUD group. We also observed no difference in the mean length of stay (adjusted coefficient 0.456, 95% CI 0.049- 0.96, p=0.077) or the mean of total hospital charges (adjusted coefficient 3882, 95% CI -10548.17- 18313.79, p= 0.60) in both groups. Conclusions: We observed that in hospitalized patients with AD, SUD is not associated with an increased risk of in-hospital mortality, however, there is a significantly increased risk of cardiogenic shock, coronary syndrome, and embolic stroke.
Abstract 11171: Smoking Modulates Response to Anti-Arrhythmic Therapy for Atrial Fibrillation Patients Across Race-Ethnicity
Authors: Ishita Aggarwal, Bahaa Al-azzam, Annette Diaz, Pranati Sreepathy, Miles Barney, Katherine Shapiro, Faisal Darbar, Aylin Ornelas, Yining Chen, Adarsh Bhan, Sreenivas Konda, David Tofovic, Dawood Darbar
Journal: Circulation (2022)

BACKGROUND: Smoking is associated with increased risk of developing atrial fibrillation (AF) and stroke. Yet, it remains unclear if it also predicts response to rhythm control therapy across race-ethnicity. We sought to determine if response to rhythm control therapy for AF is modulated by smoking across race-ethnicity. Methods: 529 patients treated with a rhythm control strategy were prospectively enrolled in the Chicagoland area. Patients were classified into White, Black or Hispanic\Latino based on race\ethnicity and ancestry markers. Rhythm control included antiarrhythmic drugs (AADs) and/or catheter ablation. Successful response was defined as continuation of the same AAD for at least 6 months and/or successful catheter ablation without recurrence of AF for 12 months. Results: 235 (44%) were Black, 192 (36%) were White, and 102 (19%) were Hispanic. 299 (57%) were treated with AADs and 230 (44%) with catheter ablation. One-hundred sixty-eight (35%) patients had a history of smoking. Baseline co-morbidities were similar across responders and non-responders. In multivariate regression analysis (Table 1), patients with a smoking history were more likely to have a recurrence of AF when treated with a rhythm control strategy (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.03-2.21, P =0.03). Stratified multivariate regression analysis showed that smokers were more likely to have a recurrence of AF after ablation therapy as compared to AADs (OR 1.49, 95% CI 1.03-2.17, P = 0.03). Multivariate logistic regression showed that patients that smoked for &gt;20 years were twice as likely to have a recurrence of AF with a rhythm control therapy than those who smoked for &lt;20 years (OR 1.88, 95% CI 1.20- 2.93, P = 0.01). Conclusions: A smoking history modulates response to rhythm control therapy for AF across race-ethnicity. Our study highlights the importance of smoking cessation before initiation of rhythm control agents in patients with AF.
Abstract 11271: Post TAVR Outcomes Among Patient With Amyloidosis and Aortic Stenosis: A Meta Analysis
Authors: Vikash Jaiswal, Song Peng Ang, Kriti Kalra, Nida Khan, Amey Joshi, Akash Jaiswal, Mounika Reddy Vadiyala, Nirmit Patel, Jia Ee Chia, Anuradha Raut, Taiba Aziz, Hasitha Manohar
Journal: Circulation (2022)

Introduction: Aortic stenosis (AS) is one of the most prevalent valvular heart diseases globally. As many as 16% of AS patients have underlying cardiac amyloidosis (CA). To date, there is a paucity of data on outcomes among AS with concomitant CA patients post-TAVR. Hypothesis: This study aimed to evaluate the clinical outcomes post TAVR among patients with CA. Methods: We performed a systematic literature search of databases for relevant articles from inception until June 01, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of &lt;0.05 was considered statistically significant. Results: 5 studies with 1,488 patients were involved in the final analysis. The mean age of patients among CA+AS and AS alone was (85 vs 80) years. The number of males affected with dual pathology was higher compared to AS alone (71% vs 59%). 29% of patients were having a right bundle branch block in the CA+AS group, while 12% were among AS alone. Mean IV Septal Thickness (1.53 vs 1.33), mean relative wall thickness (0.60 vs 0.40) and mean LA dimensions (5.19 vs 4.8) were higher among the CA+AS group compared with AS alone. At the mean follow up of 12 months the odds of in-hospital mortality (OR, 2.09(95% CI: 0.77-5.63), P = 0.15), stroke (OR, 0.46(95%CI: 0.06-3.60), P = 0.46), and vascular complication (OR, 0.19(95% CI: 0.01-3.40), P = 0.26) were comparable between both group. In contrast, the incidence of acute kidney injury (OR, 3.09(95% CI: 2.02-4.71), P&lt;0.001), and major bleeding (OR, 1.74(95% CI: 1.02-2.98), P = 0.04) were significantly higher among CA+AS group compared to AS group following TAVR. Conclusions: TAVR appeared to be a safe procedure among patients diagnosed with amyloidosis in aortic stenosis with a similar mortality rate between both groups of patients. Further studies should aim at determining the optimal valve replacement strategy in AS patients with concomitant CA.